Factors associated with tuberculosis treatment default among HIV-infected tuberculosis patients in Thailand.
Ensuring completion of tuberculosis (TB) treatment remains a major public health problem. In HIV-infected patients, TB is the most common severe opportunistic infection. Few studies have evaluated risk factors for TB treatment default in HIV-infected patients. We conducted a prospective, observational study of HIV-infected TB patients in Thailand. Patients underwent standardised evaluations at the beginning of TB treatment, at the end of the intensive phase and at the end of TB treatment. TB treatment outcomes were assessed according to WHO guidelines. The analysis was limited to patients who defaulted or who had treatment success. Of the 554 patients analysed, 61 (11%) defaulted. In multivariate analysis, factors associated with TB treatment default included incarceration history [adjusted odds ratio (AOR) 2.0, 95% CI 1.1-3.7), smoking (AOR 2.3, 95% CI 1.3-4.1) and having a symptom complaint score >15 (AOR 3.4, 95% CI 1.4-8.0); one marker of wealth, namely owning a refrigerator, was protective (AOR 0.4, 95% CI 0.2-0.8). Default during TB treatment was a significant problem in HIV-infected patients. Reducing default may require enhancing services for patients with a history of incarceration or smoking and designing patient-centred systems to address poverty and patient wellness.
Kittikraisak
Wanitchaya
W
Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
Burapat
Channawong
C
Kaewsa-ard
Samroui
S
Watthanaamornkiet
Wanpen
W
Sirinak
Chawin
C
Sattayawuthipong
Wanchai
W
Jittimanee
Suksont
S
Pobkeeree
Vallerut
V
Varma
Jay K
JK
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013785:Thailand; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents